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Burnett County 7410 County Road K, No. 102, Siren, WI 54872 Office of Zoning Administrator n z <br /> APPLICATION FOR LAND USE PERMITS g <br /> OWNER /� TELEPHONE �' <br /> MAILING ADDRESS <br /> 0 2, ZaS C Aov, i/(, iNl Sag'z 2- <br /> PROPERTY <br /> PROPERTY ADDRESS 2 30173— <br /> 01/ r/7 � 9 2-c,A gy L N s/9�-"L &.,.IL A'fl�c S <br /> LEGAL DESCRIPTION J <br /> s 3 <br /> DWELLING/BUILDING ❑ GARAGE/ACCESSORY STRUCTURE❑ ADDITION ❑ STAIRS ❑ <br /> TYPE OF PERMIT(S): I { <br /> FILLING/GRADING❑ CAMPING UNIT ❑ BUNKHOUSE ❑ 59.692(1V)GAZEBO ❑ DECKY n <br /> STRUCTURE/ADDITION USE: or- CA Z <br /> (Home/Cabin; Commercial Business; Bedroom; Deck; etc.) Ie P <br /> BUILDING CONTRACTOR: L <br /> r v <br /> A PLOT PLAN MUST BE PROVIDED ON AN 8 W X11 SHEET OF PAPER. ANY INCOMPLETE OR ILLEGIBLE PLOT PLANS +I V S <br /> WILL BE RETURNED. <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (ARIAL OR TOP VIEW) D`C 7e 0 o <br /> 1. ALL REQUIRED DIMENSIONS OR DISTANCES TO BE SHOWN OR DRAWN TO SCALE. er'n p ' <br /> 2. SHOW THE LOCATION AND SIZE OF ALL EXISTING BUILDINGS/STRUCTURES (EB)AND ALL NEW <br /> BUILDINGS/STRUCTURES (NB),INCLUDING DECKS, PORCHES AND OTHER STRUCTURES, m <br /> AND INDICATE NORTH (N). -d <br /> 3. SHOW DIMENSIONS IN FEET OF THE FOLLOWING: (A) BUILDING(S)TO ALL LOT LINES, (B) BUILDING(S) I CIJ <br /> TO CENTERLINE OF ROAD, (C) BUILDING MEASUREMENT(S)TO THE ORDINARY HIGH WATER MARK IQ)Q OR <br /> (OHWM)OF LAKE, STREAM OR RIVER AND MEASUREMENT TO WETLAND AREAS. Z <br /> 4. SHOW THE LOCATION OF THE WELL(W), SEPTIC TANK (ST)AND DRAINFIELD (DF),AND ALL DISTANCES r <br /> TO BUILDINGS, ROADS, LAKE, LOT LINES. - <br /> 5. INDICATE IF A WALKOUT BASEMENT IS PLANNED AND SHOW AREAS TO BE GRADED OR FILLED. n c <br /> 6. IF SEPARATE PLANS ARE SUBMITTED BY AN ARCHITECT, ENGINEER, BUILDER, CONTRACTOR, ETC.,THE !n <br /> PLANS MUST BE SIGNED AND DATED BY THE OWNER. t <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED SO AN ONSITE VERIFICATION MY BE DONE WHEN 5 <br /> NEEDED. c <br /> to <br /> THIS PERMIT IS SUBJECT TO ALL CONDITIONS LISTED BELOW: 00 <br /> e t <br /> e > C <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT. <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. 3 3 O <br /> 4. NO STRUCTURES,INCLUDING RETAINING WALLS, ETC.,ALLOWED WITHIN THE REQUIRED WATER <br /> SETBACK AREA. <br /> 5. ACCESSORY STRUCTURE/GARAGE PERMITS ALLOW FOR PRIVATE RESIDENTIAL GARAGE/STORAGE ONLY. <br /> NOT TO BE USED FOR HUMAN HABITATION. <br /> 6. <br /> aj`m Ra <br /> 7. v <br /> sw g <br /> Ua� G <br /> 2 .� r_.— <br /> O e a w <br /> [declare that this application(including any accompanying schedule)has been examined by me and to the best of my knowledge <br /> and belief It is true,correct and complete. I acknowledge that I am responsible for the detail and accuracy of all Information e g <br /> contained in this spoliation(Including any accompanying schedule)and I further declare that I recognize that this Information I k - a <br /> am providing will be relied upon by the County of Burnett Wisconsin In determining whether to issue a permit I further accept all <br /> liability that may be a result of the County of Burnett relying on this Information I am providing In this application. I agree to n 8 `^ 8 ` <br /> permit county oRlcle arged with adminlstra g county ordinances or other authorized person to have access to the above- e <br /> described premise ny mason ma of Inspection. <br /> W <br /> SIGN HERE 2-- 2- 1-07 r), 11{{ <br /> Su �� O <br /> (slibnature��of(o;wner or building gmtmctor) (date) 9_ <br /> u t 2 <br /> ZONING ADMINISTRATOR m } 71 a �.(! y et n �-+ ( $K-&A th <br /> TOWNSHIP PERMITS MAY BE REQUIRED <br /> THIS PERMIT SHALL EXPIRE ONE YEAR FROM DATE OF ISSUANCE v N 8 U U o <br />